Subjective Ocular Symptoms Research Articles

Real-world insights and outcomes related to ciclosporin A 0.1% cationic emulsion for the long-term treatment of dry eye disease in Germany: Country-level sub-analysis of the PERSPECTIVE study

PurposeThe PERSPECTIVE study was a real-world European, non-interventional, multicenter, observational study that evaluated the effectiveness, tolerability, and safety of ciclosporin A (CsA) 0.1% cationic emulsion (CE) in routine clinical practice as a treatment for adults with severe keratitis and dry eye disease (DED) that remained insufficiently controlled with artificial tears. This sub-analysis examined data from ophthalmology clinics in Germany to provide more precise insights into treatment patterns, outcomes, and clinical decision-making related to CsA 0.1% CE.MethodsStudy data were collected from adults starting CsA 0.1% CE (one drop in both eyes at bedtime) and followed up at Week 4, 12, and 24, and Month 12. The primary endpoint was mean change from baseline in corneal fluorescein staining (CFS) score (Oxford Grade Scale) at Month 12. Secondary endpoints examined the severity of ocular signs and symptoms, and adverse events (AEs).ResultsA total of 236 patients from 20 ophthalmology clinics in Germany participated in the PERSPECTIVE study (69.9% female; mean age 60.8 years). Following treatment with CsA 0.1% CE, patients experienced significant reductions in CFS score from Week 4, which were maintained through to Month 12 (P < 0.0001). From baseline, 81.6% of patients experienced an improvement in CFS score at Month 12. CsA 0.1% CE provided significant reductions in the severity of eyelid and conjunctival erythema at Month 12 compared with baseline (P < 0.001), as well as significant reductions in the severity of subjective ocular symptoms (all P ≤ 0.015). Safety data were consistent with the known safety profile of CsA 0.1% CE. Tolerability was rated as “satisfactory,” “good,” or “very good” by 97.2% of physicians and 95.7% of patients.ConclusionOutcomes in Germany were similar to those reported for the overall European study population and are indicative of the treatment results that ophthalmologists may expect to see with CsA 0.1% CE treatment in real-life clinical practice. Treatment with CsA 0.1% CE provided long-term improvements over 12 months and was generally well tolerated.

Outcomes of the addition of oral administration of curcumin-phospholipid to hyaluronic acid-based tear substitute for the treatment of dry eye disease.

The aim of this study is to report the clinical outcomes of oral supplementation with curcumin-phospholipid in addition to hyaluronic acid-based tear substitute for the management of dry eye disease (DED). Patients with a diagnosis of DED confirmed by pathological values of both NIKBUT <10 s. and OSDI Questionnaire score > 12 were included. Patients were randomized to receive 2 different treatments: 0.25% hyaluronic acid-based tear substitute 3 time daily (Group 1) or as above plus curcumin-phosphatidylcholine complex tablets once a day (Group 2). Patients were evaluated at baseline (T0) and after 90 days of treatment (T1) by means of Keratograph for the measurement of NIKBUT, TMH, meibomian gland dropout and bulbar redness. Overall, data from 90 eyes of 45 patients were included. Group 1 consisted of 48 eyes of 24 patients, while group 2 included 42 eyes of 21 patients. When comparing median values of both groups at T0, no statistically significant differences were found for all parameters; instead for T1, statistically significant differences were found for redness and OSDI compared to Group 1. In group 1, a statistically significant reduction after the treatment was detected for Nikbut average and OSDI questionnaire; while in group 2, a statistically significant reduction after treatment was recorded for Nikbut average, bulbar redness and OSDI questionnaire. The addition of an oral supplement containing curcumin-phospholipid may help in a greater improvement of bulbar redness and subjective ocular symptoms compared to the treatment with tear substitutes alone for the management of DED.

Conjunctival Impression Cytology and Tear Film Changes in Sarcoidosis: A Subjective and Objective Diagnosis Study.

To evaluate sarcoidosis-induced tear film changes using subjective and objective diagnostic tests, particularly conjunctival impression cytology (IC), and to compare the results with healthy individuals. This study evaluated clinical data collected between January 2019 and January 2021 from 57 right eyes of 57 sarcoidosis patients without ocular involvement (Group 1) and 33 right eyes of 33 healthy individuals with similar demographic characteristics (Group 2). The Schirmer I test, tear break-up time (TBUT), fluorescein staining, and conjunctival IC were all performed as part of the conjunctival and corneal examinations following a thorough ophthalmological examination. The Ocular Surface Disease Index (OSDI) was used to assess subjective ocular symptoms. The mean ages in Groups 1 and 2 were 49.26±3.18 and 51.91±2.89 years, respectively (p=0.720). The mean Schirmer I test, TBUT, and OSDI scores differed significantly (p<0.05 for all), with Group 1 having a significantly higher percentage of dry eyes than Group 2. Group 1 had significantly higher Nelson's grading system grades than Group 2 based on conjunctival IC analysis (p=0.001). There were no significant differences in visual acuity (p=0.17) or intraocular pressure (p=0.14) between groups. Sarcoidosis patients had significantly higher Nelson grades in conjunctival IC, as well as significantly higher percentages of dry eye as determined by the Schirmer I test, TBUT, and OSDI. Reduced tear quantity and quality may destabilize the tear film layer, resulting in a variety of ocular symptoms.

A prospective contralateral eye comparison of the tolerability of two artificial tears with different physical properties in patients with dry eye disease

Background: Artificial tears (ATs) are widely used in ophthalmic practice with various formulations, mainly as a treatment for dry eye, owing to their rapid ability to alleviate the signs and symptoms of this condition. We aimed to investigate drop comfort and subjective ocular symptoms after instillation of the following ATs with different physical properties: Optive® non-preservative (OUD) and Systane® Hydration non-preservative (SHUD).&#x0D; Methods: This was a prospective, double-blind, randomized, contralateral eye comparison study. A rheometer and a digital pH meter were used to evaluate the viscosity and pH of both ATs prior to instillation. We recruited 36 patients with dry eye disease. Single standardized AT volumes were set using a micropipette for all patients. Ocular discomfort was assessed using the Ora Calibra™ Ocular Discomfort and 4-Symptom Questionnaire (OOD4SQ; 0 – 5 scale) before and 60 min after instillation. Drop comfort was assessed using the Ora Calibra™ Drop Comfort Scale (0 – 10 scale) immediately after AT instillation. The difference in the drop comfort score (DCS) between the two ATs and ocular discomfort scores using OOD4SQ before and 60 min after instillation of each AT were recorded and compared.&#x0D; Results: The viscosities and pH of SHUD and OUD were 32.73 centipoise (cP) and 7.74 and 14.42 cP and 7.19, respectively. The mean (standard deviation) DCS was higher in the SHUD group than in the OUD group (1.83 [1.21] versus 1.67 [1.12]); however, the difference was not statistically significant (P &gt; 0.05). There was a significant reduction in all parameters of OOD4SQ including overall discomfort, burning, dryness, grittiness, and stinging 60 min after OUD instillation (all P &lt; 0.05), while a significant difference was only noted in dryness (P &lt; 0.05) in the SHUD group.&#x0D; Conclusions: OUD, which has a lower viscosity and pH compared to SHUD, provides less subjective sensation and better ocular comfort 60 min after instillation. Further randomized clinical trials including patients with dry eye disease of different severities, larger sample sizes, and longer follow-up periods are required to verify our findings.

Comparison of Subjective Visual Experiences and Ocular Symptoms After Wavefront-Guided and Wavefront-Optimized LASIK in a Prospective Fellow Eye Study

The purpose of this study was to compare the subjective visual experience and ocular symptoms of fellow eyes treated with wavefront-optimized (WFO-) laser-assisted in situ keratomileusis (LASIK) and wavefront-guided (WFG-) LASIK. Prospective randomized fellow eye, controlled study. Two hundred eyes of 100 subjects from a single academic center were enrolled and randomly assigned to treatment with WFO-LASIK in one eye and WFG-LASIK in the fellow eye. Subjects filled out a validated 14-part questionnaire for each eye at the preoperative visit and at postoperative months 1,3,6,12. In comparing the number of subjects who reported symptoms in the WFG- vs WFO- LASIK eyes, there was no difference in number reporting any visual experience (glare, halos, starbursts, hazy vision, blurred vision, distortion, double or multiple images, fluctuations in vision, focusing difficulties, and depth perception; all p>0.05) or ocular symptoms (photosensitivity, dry eye, foreign body sensation, ocular pain; all p>0.05). There was no preference for WFG-LASIK (28%) or the WFO-LASIK treated eye (29%) with most subjects reporting no preference (43%; Chi-squared p=0.972). Of the subjects who preferred one eye or the other, the preferred eye saw statistically better than the fellow eye (0.8 ± 1.4 Snellen line, p=0.0002). There was no other difference in subjective visual experience, ocular symptoms, refractive characteristics when taking into account eye preference. Most subjects had no eye preference; and for subjects who did have eye preference, the only detectable difference was better visual acuity in the preferred eye.

Effects of Serial Sessions of Activa Mask for the Treatment of Meibomian Gland Dysfunction.

To analyze outcomes on objective ocular surface parameters and subjective symptoms of serial weeklysessions using the Activa mask in patients with meibomian gland dysfunction (MGD). This is a prospective study including patients with symptomatic MGD who were treated with four weeklysessions using the Activa mask (SBM Sistemi, Turin, Italy). Noninvasive ocular surface examination was carried out before (T0) and 2weeks after the last mask session (T1) using Idra (SBM Sistemi, Turin, Italy) for the measurement of: (1) noninvasive break-up time (NIBUT); (2) lipid layer thickness (LLT); (3) tear meniscus height (TMH); (4) meibomian gland loss (MGL) of upper and lower eyelids. The I-Pen tear osmolarity system (I-Med Pharma Inc, Dollard-des Ormeaux, Quebec, Canada) was used to measure tear osmolarity values. Ocular discomfort symptoms were ascertained by means of the ocular surface disease index (OSDI) questionnaire. All 25 patients (11 males, 14 females; mean age 57.1 ± 11.9years) regularly completed the cycle of four mask sessions. No patients used prohibited medications, and no device-related adverse events were noted. At T1, mean values of NIBUT and LLT increased significantly compared to T0 (respectively from 6.0 ± 1.4 to 6.6 ± 1.2s, P = 0.043, and from 53.2 ± 17.4 to 65.3 ± 16.3nm, P < 0.001), while mean values of MGL and tear osmolarity decreased significantly (respectively from 17.1 ± 9.3 to 15.1 ± 8.0%, P = 0.014, and from 307.3 ± 12.2 to 301.5 ± 6.8mOsm/l, P = 0.005). In parallel, OSDI score reduced significantly from 62.4 ± 11.7 at T0 to 34.5 ± 11.2 at T1 (P < 0.001). Weekly serial sessions using the Activa mask significantly improved objective parameters of the ocular surface as well as subjective ocular discomfort symptoms in patients with recalcitrant MGD. As afurther benefit from the treatment, patients were able to avoid the use of concomitant medications, apart from tear substitutes, throughout the study.

Risk Factors and Clinical Characteristics of Patients with Ocular Candidiasis.

Ocular candidiasis is a critical and challenging complication of candidemia. The purpose of this study was to investigate the appropriate timing for ophthalmologic examinations, risk factors for complications of ocular lesions, and their association with mortality. This retrospective cohort study applied, using multiple logistic regression analysis and Cox regression models, to cases of candidemia (age ≥ 18 years) for patients who underwent ophthalmologic consultation. Of the 108 candidemia patients who underwent ophthalmologic examination, 27 (25%) contracted patients had ocular candidiasis, and 7 experienced the more severe condition of endophthalmitis, which included subjective ocular symptoms. In most cases, the initial ophthalmologic examination was performed within one week of the onset of candidiasis with a diagnosis of ocular candidiasis, but in three cases, the findings became apparent only after a second examination within 7–14 days after onset of candidiasis. The independent risk factor extracted for the development of ocular candidiasis was the isolation of C. albicans (OR, 4.85; 95% CI, 1.58–14.90), unremoved CVC (OR, 10.40; 95% CI, 1.74–62.16), and a high βDG value (>108.2 pg/mL) (HR, 2.83; 95% CI = 1.24–6.27). Continuous ophthalmologic examination is recommended in cases of candidemia with the above risk factors with an initial examination within 7 days of onset and a second examination 7–14 days after onset.

Local ocular surface findings in COVID-19 patients without ocular symptoms.

To investigate subjective ocular symptoms and objectively measure tear secretion in patients with a confirmed diagnosis of coronavirus disease-2019 (COVID-19). In this prospective cross-sectional study, 24 patients who had survived COVID-19 infection and 27 healthy controls were enrolled. Conjunctival impression cytology, the Schirmer test, tear-film break-up time, corneal staining scores were applied to all the participants. No significant difference was noted with regard to the gender and mean age between the two groups (p=0.484 and p=0.599, respectively). The conjunctival impression cytology analysis revealed that the density of the goblet cells was decreased, while the counts of lymphocytes and neutrophils were increased in the COVID-19 group patients when compared with ethe control group patients. When the Nelson classification was applied to the conjunctival impression cytology samples, 25% of the COVID-19 group patients and 14.8% of the control group patients exhibited changes consistent with ≥grade 2. The mean tear-film break-up time, Schirmer test, and corneal staining score results were determined to differ between the COVID-19 and control groups (p=0.02, p<0.001, and p=0.003, respectively). The present study revealed the pathological conjunctival alterations of patients with a confirmed diagnosis of COVID-19, indicating the possibility of the occurrence of pathological ocular surface alterations to even at the end of COVID-19 infection, without the occurrence of any significant clinical ocular manifestations.

Electrically Induced Blink for the Prevention of Ocular Symptoms and Blurred Vision in Patients With Acute Facial Nerve Palsy.

Objectives: Facial nerve palsy causes blurred vision and ocular discomfort due to deficits in blinking and eye closure. The objective of this study was to determine whether eye-blinks could be elicited by electrical stimulation and whether electrically induced blink would have an effect on the visual acuity and ocular symptoms in patients with acute facial nerve palsy. Methods: The zygomatic branch of the facial nerve of fifteen participants with acute facial nerve palsy was electrically stimulated in order to elicit a blink. In successful cases, the participant proceeded with a two-hour TV watching session in which an electrically induced blink was delivered every 5seconds. The control condition consisted of an otherwise similar TV watching session without electrically induced blinking. Subjective ocular symptoms were evaluated with a Dry Eye Questionnaire and visual acuity was assessed with a Logarithm of the Minimum Angle of Resolution (LogMAR) chart before and after both sessions. Results: The stimulation produced a blink in 8 participants (53%). The visual acuity in the affected eye decreased during the control session, whereas no significant change occurred during the stimulation session. The ocular symptoms were significantly reduced during the stimulation session. Conclusions: Electrically elicited blink is a promising method for reducing the eye symptoms in individuals with acute facial nerve palsy.

Cytokines Explored in Saliva and Tears from Radiated Cancer Patients Correlate with Clinical Manifestations, Influencing Important Immunoregulatory Cellular Pathways.

Although radiotherapy is a common form of treatment for head and neck cancer, it may lead to tissue damage in the salivary and lacrimal glands, possibly affecting cytokine expression in the gland fluid of treated individuals. Cytokine profiles in saliva and tear fluid of 29 radiated head and neck cancer patients and 20 controls were screened using a multiplex assay. Correlations between cytokine expression and clinical oral and ocular manifestations were examined, and cellular pathways influenced by these cytokines were assessed using the Functional Enrichment Analysis Tool. Significantly elevated cytokines identified in patient saliva were CCL21, IL-4, CX3CL1, CCL2, CXCL1 and CCL15. Many of these cytokines correlated positively with objective signs of oral dryness, and reduced saliva production in the patients. Although CCL21 and IL-4 levels were significantly lower in patient tear fluid, they correlated with subjective ocular symptoms. These increased salivary cytokines affected pro-inflammatory and apoptotic cellular pathways, including T cell signalling, several interleukin signalling pathways, TNF and TGF-β receptor signalling, and the apoptotic p53 pathway. In conclusion, the upregulated salivary cytokines identified suggest an interplay between innate and adaptive immunity, affecting immunoregulatory cellular pathways. Whether this is due to late effects of radiotherapy or tissue repair remains to be investigated.

Demodex-Mite Infestation in Cilia and its Association With Ocular Surface Parameters in Japanese Volunteers.

To investigate the presence of Demodex mites on the eyelashes of a Japanese population and to explore its associations with subjective ocular symptoms and clinical ocular surface signs, including lid margin findings and fluorescein breakup time (FBUT). Sixty-three Japanese Tokyo-based volunteers were examined (24 men and 39 women; mean±SD of age, 50.6±15.8 years). Eyelash sampling was performed by epilating three lashes from the center of the right upper eyelid. Eyelashes were tested for Demodex mites with a light microscope. The subjects completed questionnaires to assess subjective symptoms and risk factors for dry eye disease (DED) and underwent general examinations for DED, including FBUT and cornea-conjunctival staining with fluorescein. Meibomian gland function was also investigated in lid margin findings, vascularity and mucocutaneous junction movement, lid irregularity, plugging, pouting, and meibum secretion grade scores. Demodex mites were found in 20.6% (13/63) of the volunteers. Lid margin vascularity and meibum grades in the upper eyelid margins were significantly associated with the presence of Demodex mites. However, there were no significant differences in the diagnosis of meibomian gland dysfunction, FBUT, or ocular surface discomfort between the subjects with or without Demodex mites. Demodex mites are not rare in the cilia of a Japanese population. Lid margin vascularity and lower meibum quality may be associated with the presence of Demodex mites.

Effects of prolonged continuous computer gaming on physical and ocular symptoms and binocular vision functions in young healthy individuals.

Background and ObjectiveAddiction to computer gaming has become a social problem in Korea and elsewhere, and it has been enlisted as a mental health disorder by the World Health Organization. Most studies related to computer use and vision have individually assessed physical and ocular symptoms and binocular vision. Accordingly, the present study comprehensively assessed subjective physical and ocular symptoms and functions related to binocular vision after prolonged continuous computer gaming. This study aimed to investigate the effects of prolonged continuous computer gaming on physical and ocular health and visual functions in young healthy individuals.MethodsFifty healthy college students (35 male/15 female), aged 19–35 years old, were enrolled in this study. The inclusion criteria were no binocular vision problems and no reported history of ocular disease. Participants played continuously for 4 h from 6:00 to 10:00 p.m. Physical and ocular symptoms and visual functions such as convergence, accommodation, phoria, and the blink rate were assessed before and after continuous computer gaming for 4 h.ResultsContinuous computer gaming for 4 h resulted in convergence and accommodation disturbances and increased physical and ocular discomfort. Near phoria showed an exophoric shift, whereas distance phoria showed no change. Moreover, the accommodative and vergence facilities and blink rate were significantly decreased. All visual functions recovered to the baseline levels by the following morning.DiscussionOur findings suggest that excessive and continuous computer gaming impairs visual functions and causes ocular and physical fatigue. Our findings further the understanding of the adverse effects of excessive computer use on physical and ocular health, and adequate breaks are necessary to reduce physical and visual discomfort during computer gaming.

Comparing Pre-Lens Non-invasive TBUT with Two Different Silicone Hydrogel Contact Lens Materials

Purpose : To compare pre-lens non-invasive tear break-up time(NITBUT) and subjective ocular symptoms with two different silicone hydrogel lens materials. Methods : Samfilcon A and Comfilcon A lenses were worn on the right and left eyes of 32 (23.5± 2.92 years, female: 24, male: 8), respectively. After Each subjects attended three visits (on day 1 after 3 hours: on days 1 and 7 after 9 hours of wear), visual acuity using high (100%) and low (10%) contrast chart and pre-lens NITBUT using Keratograph 5M were measured. The subjects were surveyed with questionnaire for subjective ocular symptoms in terms of discomfort, dryness, changeable vision, closing eyes and removing lenses. Results : High and low contrast visual acuity, and pre-lens NITBUT values were not significantly different between Samfilcon A and Comfilcon A. There was no significant difference in visual acuity and NITBUT change during 7 days of wearing each lens. The relative frequency of subjective symptoms of 5 items related to wearing contact lenses was not significantly different in all items, the responses of the wearers in terms of lens preference were not statistically different (40.6%, 37.5%, respectively). Conclusion : The study demonstrates similar clinical results for pre-lens NITBUT and subjective ocular symptoms with Samfilcon A and Comfilcon A. The two silicone hydrogel lenses could not find the difference between the two lenses in the lens wearer despite difference lens materials and manufacturers.

Eye symptoms and visual functioning in a modern office: Subjective and clinical signs at an “in office” eye examination

Purpose: One of the problems that occur with symptoms of ocular discomfort is the variety of subjective complaints. The indoor environment and reading tasks or computer work during the day is known to exacerbate symptoms. By examining the eyes “in-office”, environmental conditions can be considered as a constant in all participants, leaving only subjective ocular symptoms and clinical signs for investigation.

Changes in tear volume and ocular symptoms of patients receiving oral anticancer drug S-1

BackgroundMost eye disorders are not fatal but may deteriorate the quality of life of a patient. The eye disorder that is most frequently reported in the cancer chemotherapy is associated with the combination of tegafur/gimeracil/potassium oxonate (S-1). However, preventive methods or treatment methods for the eye disorder have not yet been established. This study aimed to determine changes in tear volume and subjective ocular symptoms during the treatment period in patients receiving S-1 monotherapy for early detection of adverse effects in the eye and establishment of its treatment methods.MethodsThis study included eleven patients receiving S-1 monotherapy as a postoperative adjuvant chemotherapy for gastric cancer. Six subjective ocular symptoms including watering eyes were evaluated and changes in tear volume measured by the Schirmer’s test in patients receiving S-1 during the treatment period. In the present study, the patients were divided into “no watering eyes” (patients not experienced watering eyes) group and “watering eyes” (patients experienced watering eyes even once) group.ResultsSix out of eleven patients developed watering eyes after receiving S-1 monotherapy. Among these, the earliest onset occurred on the 2nd week after oral administration. Watering eyes and eye discharge were highly related in patients having a trouble in daily life due to the decreased QOL. Changes in tear volume in the “watering eyes” group significantly increased compared to the “no watering eyes” group during the treatment period, especially when the patients had no subjective symptom of the increased tear volume.ConclusionsIt is essential to prevent eye disorders including watering eyes as an adverse effect of S-1 administration. The present study recommends that the tear volume should be periodically measured using Schirmer’s test, and the patient should be interviewed regarding the subjective ocular symptoms for the early detection of watering eyes caused by S-1 administration. If the tear volume can not be measured periodically, medical staffs should pay attention to the patient with eye discharge.

Comparison of Visual Quality and Subjective Ocular Symptoms with Comfilcon A Silicone Hydrogel Contact Lens Wearing Times

Purpose: To compare the visual quality and subjective ocular symptoms with Comfilcon A silicone hydrogel contact lens wearing times. Methods: Twenty seven subjects (24.30 ± 2.96 years, 14 females, 13 males) took part in this study. Subjects were fitted with silicone hydrogel contact lenses providing best-corrected visual acuity. Best-corrected visual acuity (VA) at two contrast levels (100% and 10%) and best-corrected contrast sensitivity (CS) for four spatial frequencies (3, 6, 12 and 18 cycles/degree) were measured under photopic and mesopic conditions. Corneal higher-order aberrations (HOAs) were measured with 4-mm and 6-mm pupils using Wavefront Analyzer. Subjects were asked to complete the questionnaire for subjective ocular symptoms related contact lens. All measurements and questionnaires were performed after wearing silicone hydrogel lenses for 2 hours and 9 hours in a day. Results: Regarding visual quality under photopic and mesopic conditions, there was no statistically significant difference between 2 hours and 9 hours wear in high contrast, low contrast VA and CS. We also did not find out any significant changes in corneal HOAs, including third-order, fourth-order, coma, and spherical aberration for both 4-mm and 6-mm pupils between the two wearing times. Among the relative frequency items of subjective ocular symptoms related contact lens, there were statistically differences between 2 hours and 9 hours wear in discomfort, dryness, and closing eyes (p=0.031, p=0.001, and p=0.031, respectively). Conclusion: It can be identified that Comfilcon A silicone hydrogel contact lenses showed no change in the optical quality and visual quality of the eye for more than 9 hours wear. However, uncomfortable ocular symptoms and dryness increased as much as wearing time of the silicone hydrogel contact lens was longer. Thus, guidance of contact lens care to reduce those symptoms is considered necessary.

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

Objective: The purpose of this study was to evaluate the efficacy and safety of 0.1% tacrolimus eye drops in the tarsal form of vernal keratoconjunctivitis (VKC) and to survey the changes of dendritic cells at the palpebral conjunctiva in patients with VKC by in vivo confocal microscopy. Methods: A total of 17 patients (34 eyes) with the tarsal form of VKC were enrolled in this prospective, nonrandomized case series. They were treated with 0.1% tacrolimus eye drops twice daily after discontinuation of all other topical medications. Subjective ocular symptoms and objective ocular signs were scored on a 4-point scale by one ophthalmologist and the characteristics of the dendritic cells in each right eye at the palpebral conjunctiva were evaluated by in vivo confocal microscopy before treatment and at the 1st, 2th, 4th, and 8th weeks after treatment. Results: After 1 week of treatment with 0.1% tacrolimus eye drops, the score for each symptom in all patients showed a significant (p < 0.001) improvement, and 13 patients (76%) experienced dramatic relief of symptoms. In addition, there was a significantly (p < 0.001) decreased clinical sign score (except for giant papillae) after 4 weeks, and a significant (p < 0.001) improvement in the score of giant papillae after 8 weeks of treatment. The characteristics of dendritic cells (including cell count, total area, average size, perimeter, and diameter) showed a significant (p < 0.05) decrease after 2 weeks of treatment. During the follow-up, no other topical medications were required and no significant changes in visual acuity were documented. No cataracts or elevation of intraocular pressures were detected. Only 5 patients (29%) had a tingling or burning sensation or discomfort. Conclusions: Tacrolimus 0.1% eye drops are an effective and safe treatment for the tarsal form of VKC, and can rapidly inhibit the activity of dendritic cells, improve symptoms, reduce papillary hyperplasia, and reverse damage at the palpebral conjunctiva. The side effects could affect the compliance of some patients.

Risk Factors Associated with Retinal Lesions Resulting from Widespread Systemic Infection

To clarify the prevalence, microbiologic features, and risk factors of endogenous intraocular infections in patients with positive fungal or bacterial blood culture results. Retrospective case series. Inpatients (n = 433) with positive blood culture results who underwent an ophthalmology consultation between January 2006 and September 2012 in Japan. We retrospectively reviewed the ophthalmology consultations of 433 inpatients with positive blood culture results. Clinical features of patients with confirmed chorioretinitis or endophthalmitis were analyzed through descriptive statistical methods and univariate and multivariate models. Correlation of clinical features with retinal lesions of disseminated bacteremia or fungemia. Among 433 inpatients with positive blood culture results, 116 (26.8%) were unresponsive and 27 (6.2%) had subjective ocular symptoms. Eighty-four (19.4%) had candidemia, including 16 (3.7%) with retinal lesions. Additionally, 34 patients (7.8%) had chorioretinitis or endophthalmitis in 1 eye (17 patients [3.9%]) or both eyes (17 eyes [3.9%]; 51 eyes total). Of these 34 patients, 20 (58.8%) and 17 (50%) had systemic bacterial and fungal infections, respectively (both infections were noted in 3 patients [8.8%]). Staphylococcus aureus was the most common bacteria. Candida albicans was the most common fungus, followed by Candida glabrata. Catheter-related bloodstream infections were the most common source of infection among the 34 patients with chorioretinitis or endophthalmitis, followed by infective endocarditis, urinary tract infection, and soft-tissue and bone disease. Among the 114 bacteremic patients who underwent an ophthalmology consultation because of suspicion of infective endocarditis, only 16 (14%) had infective endocarditis, of whom only 1 (0.88%) had retinal lesions. Nineteen of 34 patients (55.9%) with retinal lesions survived sepsis. Among them, only 1 patient (5.3%) with bacteremia lost significant vision (no light perception), and the remaining 18 patients (94.7%) regained vision. No patient with candidemia had vision loss. Multivariate analysis revealed that candidemia, infective endocarditis, broad-spectrum antibiotic use, and eye symptoms were independent predictors of retinal lesions (all P < 0.05). An ophthalmology consultation may be useful for patients with candidemia, infective endocarditis, broad-spectrum antibiotic use, or ocular symptoms. However, routine ophthalmologic evaluation may be less efficient for bacteremic patients without definitive infective endocarditis lacking other risk factors.

Factors Associated with Visual Fatigue from Curved Monitor Use: A Prospective Study of Healthy Subjects.

PurposeTo investigate the factors associated with visual fatigue using monitors with various radii of curvature.MethodsTwenty normal healthy adults (8 men, 12 women; mean age, 26.2 ± 2.5 years) prospectively watched five types of monitors including flat, 4000R, 3000R, 2000R, and 1000R curved monitors for 30 min. An experienced examiner measured the ophthalmological factors including near point of accommodation (NPA), near point of convergence (NPC), refraction, parameters during pupil response at light and saccadic movement just before and after the visual tasks. The questionnaires about subjective ocular symptoms were also investigated just before and after the visual tasks.ResultsThe NPA increased after the visual tasks with a flat monitor compared with the curved monitors, with the 1000R curved monitor showing the smallest change (p = 0.020). The NPC increased for every monitor after the visual tasks; the largest increase occurred with the flat monitor (p = 0.001). There was no difference in refractive error, pupil response, or saccadic movement in the comparison of before and after the visual tasks. Among the nine factors in the questionnaire, the score of “eye pain” was significantly higher for the flat monitor versus the 1000R curved monitor after the visual tasks (p = 0.034).ConclusionsWe identified NPA, NPC, and eye pain as factors associated with visual fatigue. Also, the curvature of the monitor was related to the visual fatigue.

Ocular symptoms reported by patients infested with Demodex mites.

The purpose of this study was to determine subjective ocular symptoms occurring in patients infested with Demodex. The number of Demodex mites in the obtained material that correlated with the appearance of ocular symptoms was estimated. The study material were eyelashes collected from 1499 patients. The material were observed under a light microscope. T-test, the logistic regression method, and Pearson correlation coefficient were used for the analysis. Demodex mites were detected in 47% patients. The mean ages of infected women and men were 64 and 59 years, respectively. 64% infected patients complained of one or more ophthalmological symptoms. The most commonly reported symptoms included itching (28%), redness of eyelids (21%), and watery eyes (15%). Positive correlation was found between itching, redness, pain, purulence or eyelash loss and the presence of Demodex. The mentioned symptoms increase the probability of Demodex infestation in a statistically significant manner (p<0.005). A correlation between the age and gender and the number of Demodex was revealed by the study. The threshold average number of seven Demodex mites per eight collected eyelashes with which the risk of the occurrence of an ocular symptom increases significantly was defined. In patients with a low number of Demodex mites, symptoms may be absent. The risk of the occurrence of ocular symptom in patients with demodicosis increases with the increase in the average number of Demodex mites.